正常青春前期、青春后期儿童血中Leptin水平与生长激素结合蛋白关系的研究

目的研究Ｌｅｐｔｉｎ与营养、生长的关系。方法对４９例正常青春前期及４８例正常青春后期儿童进行身高、体重测量及血Ｌｅｐｔｉｎ、生长激素结合蛋白（ＧＨＢＰ）检测。结果正常青春前期儿童血Ｌｅｐｔｉｎ水平在女孩（４９１±２７９）μｇ／Ｌ,较男孩（３７１±３５５）μｇ／Ｌ略高,但无显著性差异（Ｐ＞００５）;在青春后期女孩（１２７９±７７２）μｇ／Ｌ,较男孩（４３４±３２５）μｇ／Ｌ显著升高（Ｐ＜００１）。无论青春前期还是青春后期男、女孩血中Ｌｅｐｔｉｎ水平均与ＧＨＢＰ、体重指数（ＢＭＩ）显著相关。结论Ｌｅｐｔｉｎ很可能是一种营养与生长间的调节因子并且可能具有多种功能。     

碘造影剂对儿童肾脏功能影响的前瞻性研究

为探讨造影剂对儿童肾功能的不良影响 ,以及水化对造影剂相关性肾病 (CAN)的预防作用 ,将需做静脉肾盂造影或增强CT的30例患儿 ,采用前瞻性随机对照方法 ,随机分为水化组 (HG)和非水化组 (NHG) ,HG于造影后立即给予1/5张含钠维持液20ml/kg ,NHG不予静脉补液。结果显示 ,造影后HG血清肌酐 (Scr) (49.9μmol/L±6.2μmol/L)低于NHG(58.0μmol/L±11.8μmol/L) ,P<0.05 ;而内生肌酐清除率 (Ccr)HG(89.3ml/min±13.2ml/min)明显高于NHG(70.9ml/min±8.8ml/min) ,P<0.05。HG患儿的Scr、Ccr在造影前后差异无显著性 ;虽然NHG患儿造影前后Scr无明显变化(53.1μmol/L±8.0μmol/Lvs58.0μmol/L±11.8μmol/L,P<0.05) ,但Ccr造影后明显降低 (95.9ml/min±14.4ml/minvs70.9ml/min±8.8ml/min,P<0.05)。CAN发病率为16.7 % ,HG无1例发生CAN ,而NHG5/15例发生CAN(33.3% )。其中4例在3天后Scr及Ccr恢复至造影前水平。本研究中基础Scr>61.9μmol/L的3例患儿有2例发生CAN(66.7% )。表明儿童应用碘造影剂后可出现可逆性的CAN ;造影后即刻给予水化可有效地预防CAN的发生 ;儿童Scr>61.9μmol/L时做IVP或增强CT时 ,应密切观察肾功能的改变     

Vitamin A status in children with asthma

Low vitamin A levels have been found in a number of diseases in children. The aim of this study was to examine the vitamin A status in children with asthma and to correlate the changes with severity of disease. Serum levels of vitamin A, retinol‐binding protein (RBP), and albumin were estimated in 35 asthmatic children (24 males) in the age group of 2–12 years (mean 5.89 years) and 29 controls (19 males). Both study and control groups were similar with respect to age, sex, and overall nutritional status. Twenty‐four children in the study group (68.6%) had moderate to severe persistent asthma and eight children had mild persistent asthma. Only three patients suffered from mild intermittent asthma. Vitamin A levels in children with asthma (mean ± SD 22.14 ± 5.38 µg/dl) were found to be significantly lower than their controls (mean ± SD 27.54 ± 4.83 µg/dl) (p = 0.0001). Age, age of onset of asthma, and gender had no correlation with serum vitamin A levels. Low serum vitamin A levels (< 20 µg/dl) were observed four times more commonly in the study group (28.6%) than controls (6.9%). Severity of asthma had a negative correlation with serum vitamin A levels (r = ? 0.61, p = 0.0001). Children with severe persistent asthma had markedly low serum vitamin A levels (mean ± SD 13.42 ± 5.19 µg/dl) as compared with mild intermittent asthma (mean ± SD 24.61 ± 2.32 µg/dl). Therapeutic trials are needed to prove whether low vitamin A levels contribute to asthma severity and the clinical utility of vitamin A supplementation in asthmatic children.     

Tubular and glomerular function in children after renal transplantation

Glomerular and tubular function of transplanted kidneys were assessed in 46 children aged 15.7 +/- 4.6 yr, 4.2 +/- 2.8 yr after renal transplantation. There were 34 cadaveric, and 12 living-related donors. Twelve patients (26%) had acute episodes (acute tubular necrosis, rejection, or urinary tract infection) during follow-up. All patients were on triple immunosuppression. The mean serum creatinine was 1.5 +/- 0.6 mg/dL. Creatinine clearance (Ccreat) calculated from a 24-h urine collection was 48.0 +/- 19.7 mL/min/1.73 m(2), and that estimated from the Schwartz formula, 61.0 +/- 22.5 mL/min/1.73 m(2). A positive correlation was found between the calculated and estimated clearances. Mean urine concentrating ability was 487 +/- 184 mOsmol/kg, with a value lower than 400 mOsmol/kg in 35% of patients. There was a positive correlation between urine osmolality and estimated Ccreat. Metabolic acidosis (bicarbonate <22 mmol/L) was found in 41% of patients, with relatively alkaline urine and high chloride level. Fractional excretion (FE) of sodium was above 1% in 68% of patients (mean 1.66 +/- 1.06%), and FE(Mg) was above 3% (mean 10.9 +/- 5.2%) in 93% of patients. Tubular reabsorption of phosphate (TP)/glomerular filtration rate (GFR) was 3.2 +/- 0.8 mg/dL glomerular filtrate (GF). FE(K), FE(UA), and Ca/creatinine in urine were normal. There were no functional group differences between the cadaveric and living-related kidneys. Significant group differences were found in those with acute episodes and those with a normal course. Estimated Ccreat was 54 +/- 20 vs. 67 +/- 20 mL/min/1.73 m(2) in the acute episodes and the normal course groups, respectively. Also, the FE(NA), FE(UA), and FE(Mg) were higher in the acute episodes group -2.3 +/- 1.6, 10.6 +/- 4.4, and 14.8 +/- 6.5%, respectively, compared with the normal course group -1.4 +/- 0.6, 8.2 +/- 2.8, and 9.6 +/- 4.0%, respectively. There were no between-group differences in plasma bicarbonate, FE(K), TP/GFR, and urine osmolality. We believe that most, if not all tubular dysfunctions in the transplanted kidney are secondary to renal failure and interstitial damage from acute episodes and nephrotoxic drugs. These dysfunctions are similar to those in chronic renal failure, where interstitial fibrosis plays a role in kidney function deterioration.     

Risk factors for persistent hyperparathyroidism in children with stable renal function after kidney transplantation

This study aimed to investigate the risk factors for PHPT in children with stable renal function who received KT. We retrospectively analyzed the clinical findings and laboratory results of patients who underwent KT below 19 years of age, between 1996 and 2016 at our hospital. Patients were followed up for more than 1 year after KT. We calculated the mean ± standard deviation or median [minimum – maximum] for each parameter. We included a total of 46 patients (male:female = 26:20). Twelve patients (26.1%) were included in the PHPT group, and 34 (73.9%) were in the nPTH group. The dialysis duration was 57.1 ± 49.9, 44 [0‐145] months in the PHPT group and 23.5 ± 25.8, 15 [1‐121] months in the nPTH group (P = .040). The post‐KT total CO₂ level was significantly higher in the PHPT group (P = .022). The pre‐ (P = .021) and post‐KT (P = .005) and 3‐month average (P = .018) iPTH levels were also significantly higher in PHPT group. The height z‐score showed a negative correlation, and the pre‐KT, 3‐month average phosphorus and alkaline phosphate levels showed positive correlations with iPTH levels, at 1 year after KT. Patients who undergo prolonged durations of dialysis, have increased iPTH levels before and after KT, and have low bicarbonate levels after KT are at risk of PHPT and should be monitored carefully.     

Cyclosporine drug monitoring with C0 and C2 concentrations in children with stable renal allograft function

Cyclosporin A (CsA) has a narrow therapeutic window and necessitates monitoring of blood concentration. We aimed to evaluate trough (C0) and second hour (C2) level after ingestion of drug monitoring in renal allograft recipients. In this retrospective study, 12 children eight boys and four girls; mean age at transplantation 14.6 +/- 3.7 yr (ranges: 7.0-19.0), mean age post-transplant 17.8 +/- 4.9 yr (ranges: 9.0-24.0) who were transplanted >6 months were enrolled in this evaluation. Ten were recipients of a living related donor and two deceased donor grafts. While six children were receiving CsA, steroids and azathioprine, the other six received CsA, steroids and mycophenolate mofetil. Clinical course, blood pressure, renal and liver function tests were recorded. Mean C0 and C2 were 96.2 +/- 59.5 and 504 +/- 305.4 ng/mL respectively. Mean serum creatinine level was 1.2 +/- 0.45 mg/dL and mean creatinine clearance (CrCl) was 89.2 +/- 36.8 mL/min/1.73 m2. There was a correlation between serum creatinine level, CsA dose and C2 levels,whereas,there was no correlation between age, blood pressure, CrCl and C2 levels. However, no correlation was found between C0 levels and any of the above parameters. In conclusion, our data suggest that C2 levels are correlated better with dose and serum creatinine level.     

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目的研究注意缺陷多动障碍(ADHD)儿童冲动行为与其执行功能的相关关系。方法对2005年1月至2007年7月在中南大学湘雅二医院精神卫生研究所、郑州市第九人民医院心理科、郑州市儿童医院保健部的187例ADHD儿童(均符合DSM-IV注意缺陷多动障碍的诊断标准)与126名对照组儿童分别进行Barratt冲动性量表中文版(BIS)和威斯康星(WCST)卡片分类测验。结果ADHD冲动组、ADHD非冲动组和对照组组间WCST的评分差异无统计学意义(P>0.05),BIS的3个因子及冲动总分与WCST卡片分类测验的非持续性错误数呈显著的负相关(P<0.05)。结论ADHD儿童与对照组儿童的执行功能差异无统计学意义(P>0.05),但冲动行为越强烈,儿童出现随机错误的可能性越大。     

Nephrotoxicity following carboplatin use in children: Is routine monitoring of renal function necessary?

Carboplatin is an effective chemotherapeutic agent against many solid tumours. Although it is thought to be less nephrotoxic than its precursor cisplatin, current paediatric treatment protocols require regular monitoring of renal glomerular function during and after carboplatin use. Because accurate assessment of renal function in children requires measurement of isotope-clearance glomerular filtration rates (GFRs), routine monitoring is costly and time consuming. We studied 26 paediatric patients who were receiving chemotherapy that included 500–600 mg/m² of carboplatin per course. ⁵¹Cr-EDTA GFRs were measured initially and after one to seven courses (median four). There was no measurable difference between renal function before and after carboplatin (P = 0.8). Our study shows that routine monitoring of renal glomerular function is unnecessary. Carboplatin use in patients who have had unilateral nephrectomy as part of their treatment is also discussed. Paediatric oncology literature concerning nephrotoxicity and carboplatin is reviewed. © 1993 Wiley-Liss, Inc.     

Donor and recipient ACE I/D genotype are associated with loss of renal function in children following renal transplantation

Genetic polymorphisms of the RAS correlate with allograft function. We therefore analyzed common RAS polymorphisms in kidney donors and in children following RTx to determine the relationship between genotype and decline in GFR, blood pressure, and LVM. A total of 107 children who underwent RTx were included: 70 male, 37 female, mean age 8.8±4.9 yr, mean follow up 5.4 yr. The following RAS polymorphisms were studied in all 107 recipients, 48 donors, and 120 healthy controls: Renin (Renin Mbol 18G/A), ACE I/D; angiotensinogen (AGT M235T), and angiotensin II receptor type-1 (AT1R A1166C). Only patients homozygous for the ACE D allele had a significantly steeper decline in GFR compared with homozygous carriers of the ACE I allele (slope DD: -4.3±0.8 vs. II: -1.3±1.1 mL/min/1.73 m2 per yr; p=0.035). In four cases, a DD recipient received a kidney from a DD donor, and these patients showed a more pronounced decline in GFR (-5.2±0.5 mL/min/1.73 m2 per yr; p=0.002). MABP was not different before vs. after RTx and was independent of ACE I/D genotype. LVMI increased significantly in the majority of patients (36.6±13.9 g/m2.7 six months before RTx vs. 46.4±15.3 g/m2.7 12 months after RTx, p=0.015). However, this difference disappeared after stratification by ACE I/D genotype. The ACE DD genotype is a potential marker for identifying patients at high risk of poor allograft outcome.     

两种标准筛查儿童超重和肥胖的比较

目的 探讨更适合中国儿童的超重、肥胖初筛标准.方法 对广西南宁地区13万余儿童(年龄7～18周岁)进行流行病学调查,参照国内、国际两种儿童超重及肥胖标准进行分析比较.结果 大多数年龄组超重及肥胖儿童国内标准的检出率均高于国际标准,肥胖的发生率在7～10岁组升高,男童超重及肥胖的检出率高于女童.结论 使用国内的儿童超重及肥胖标准可能更有利于我国儿童青少年超重、肥胖的早期干预.     

癫癎儿童拉莫三嗪的群体药代动力学研究

目的：用NONMEM软件建立中国癫癎儿童拉莫三嗪（LTG）的群体药代动力学（PPK）模型。方法：回顾性收集服用LTG的癫癎165名患儿的303份血样浓度数据及临床资料,血药浓度为临床常规监测的稳态浓度,采用反相高效液相色谱法测定。应用PPK专业软件NONMEM,按照一室一级吸收和消除模型,建立我国癫癎儿童LTG的PPK模型。用平均预测误差（ME）、标准平均预测误差（SME）、平均方差（MSE）、平均根方差（RMSE）及加权残差（WRES）作为模型预测准确程度和精密程度的评价指标,对基础模型和最终模型的预测效能进行比较。结果：LTG的基础模型为：CL/F=0.664×EXP［ETA(1)］,V/F=45×EXP［ETA(2)］,KA=4.0×EXP［ETA(3)］;最终回归模型为：CL/F=0.717×(1-0.601×VPA)×(1+1.18×EI)×［1.62∧(AGE/7.02)］×EXP［ETA(1)］,V/F=40.2×EXP［ETA(2)］,KA=3.27×EXP［ETA(3)］。CL/F、V/F、KA的群体典型值分别为1.16 L/h(0.042 L/h?kg)、40.2 L(1.46 L/kg)和3.27/h。经过内部验证和外部验证,所建立的最终模型有良好的稳定性和预测效能。结论：应用NONMEM软件成功地建立了我国癫癎儿童LTG的PPK模型,可准确的预测LTG血药浓度,促进了个体化给药方案的实施。     

Circadian rhythm of blood pressure in children with reference to normal and diseased children

Circadian rhythms of blood pressure in children were investigated using ambulatory blood pressure monitoring (ABPM). The subjects were 58 normal children (26 boys and 32 girls), 10 children with orthostatic dysregulation (OD) consisting of (three boys and seven girls) and 13 children taking prednisolone (nine boys and four girls). Systolic pressure in the normal group increased from early morning, peaked in the afternoon and gradually dropped thereafter. Blood pressure in the 22:00–05:30 h time range was significantly lower than in other time ranges. Blood pressure in the OD group was generally lower than in the normal group, while that in the steroid group tended to be higher. Systolic mid-line estimating statistic of rhythm (MESOR) was significantly higher in boys than girls in both 10–12 year olds and 13–15 year olds according to Cosinor analysis. However, no increase in MESOR was observed in either boys or girls between the 10–12 year and 13–15 year age groups. The OD group showed lower diastolic MESOR than the normal group and the steroid group showed higher systolic MESOR. Seventy-two per cent of those in the normal group manifested significant circadian rhythm. Only 50% of 10 12 year olds manifested circadian rhythm, whereas the figure for 13–15 year olds increased to 80–90%, suggesting that a pacemaker regulating circadian rhythm comes into effect at puberty. The percentage of those who manifested circadian rhythm in the OD group and steroid group was about 60%, lower than in the normal group.     

矮小儿童血浆ghrelin及GHBP变化及其与生长的关系

目的 检测矮小儿童血浆ghrelin及生长激素结合蛋白(GHBP)水平变化,探讨其在矮小儿童生长发育中的作用.方法 收集就诊的矮小儿童70例,根据生长激素刺激试验GH峰值<7 ng/ml、7～10ng/ml、>10ng/ml分为生长激素缺乏组1(GHD 1,加例)、生长激素缺乏组2(GHD 2,20例)及特发性矮小组(ISS,30例);抽取20例年龄、性别相匹配的正常身高儿童作为对照组.对其进行全面的病史采集和体格检查,并检测血浆ghrelin及血清GHBP水平.采用方差分析、卡方检验及多元回归分析等统计学方法对结果进行分析.结果 GHD 1组血浆ghrelin水平低于其余三组[(4.21±2.70)ng/ml对(6.12±2.16)ng/ml、(6.20±2.75)ng/ml、 (5.11±2.53)ng/ml,P均<0.05];GHD 2组与ISS组血浆ghrelin水平近似,高于正常对照组[(6.12±2.16)ng/ml、(6.20±2.75)ng/ml对(5.11±2.53)ng/ml,P<0.05)].对ghrelin进行多重线性回归分析得出体重为ghrelin的独立影响因素(β=-188.46,P<0.000 1).GHD 1组血清GHBP水平与正常对照组差异无统计学意义[(3 869.6±702.1)pmol/ml对(4 192.9±1 043.5)pmol/ml,P>0.05)];GHD 2组与ISS组血清GHBP水平近似,均低于正常对照组[(3 584.2±469.5)pmol/ml、(3 443.5±568.4)pmol/ml对(4 192.9±1 043.5)pmol/ml,P<0.05)].结论 血浆ghrelin在不同的矮小症中所扮角色不同,GH峰值<7 ng/ml中为病因之一;而GH峰值>7 ng/ml的矮小症中为对低体质量的适应性代偿.ISS及GHD 2组血清GHBP水平低下,提示这两组中存在生长激素受体(GHR)突变.     

Assessment of left ventricular diastolic function by Doppler tissue imaging in children with end-stage renal disease

AIM: To evaluate left ventricular (LV) diastolic function in children with end-stage renal disease (ESRD) using conventional pulsed-Doppler echocardiography and Doppler tissue imaging (DTI), and to compare the findings with these two modalities. METHODS: Twenty-four children with ESRD and 22 healthy age- and sex-matched control subjects were assessed with conventional Doppler echocardiography and DTI. The scans of the renal disease patients were done after a dialysis session. Parameters related to LV systolic and diastolic function were compared in the ESRD and control groups. RESULTS: The ESRD patients had lower mean mitral E/A ratio both according to conventional Doppler echocardiography and TDI than the control subjects. The ESRD group also had significantly longer isovolumetric relaxation time (116+/-31 ms vs 97+/-3.1 ms, respectively; p<0.001), and significantly longer deceleration time (235+/-44 ms vs 202+/-35 ms, respectively; p<0.01) than the control group. CONCLUSION: DTI findings correlate well with conventional Doppler echocardiography findings. Children with ESRD show, after dialysis, echocardiographic signs of LV diastolic dysfunction.     

Comparison of quality of life between asthmatic and healthy school children

There are only a few studies which have assessed the impact of asthma on the quality of life (QoL) compared to healthy children. In this study we wanted to compare QoL between asthmatic and healthy children in a population based setting. We surveyed 2159 children aged 11-15 yr with a Child Health Questionnaire; a generic QoL measure for children. This method gives a profile of the QoL consisting of 11 scales giving a range from 0 to 100. Asthma was defined based on the ISAAC questionnaire on asthma and asthma symptoms. In all, 192 children (8.9%) reported to have asthma diagnosed by a doctor and 61 of them (2.8% of all children) had been symptomatic during the previous month. Among these symptomatic children significantly impaired QoL was observed in 8 of the 11 scales compared to non-asthmatics. The most affected scales were those defining the physical part of child's QoL: Mean General Health scores were 60 for asthmatic and 74 for non-asthmatic children and mean Bodily Pain scores 71 and 86, respectively. Symptoms during longer periods were associated with an overall decreased QoL. In conclusion, a child's asthma impairs the QoL and especially the physical dimensions.     

Value of serum cystatin C in estimating renal function in children with non‐renal solid organ transplantation

Children with non‐renal solid organ transplants are surviving longer, but outcome is complicated by CKD. Accurate and frequent renal function monitoring is imperative to recognize and institute measures early to reverse, prevent, or arrest progression. This study of 59 children determined the accuracy (P30), bias, sensitivity and specificity between measured renal function by NM‐GFR, and estimated GFR by three formulas: Filler (serum cystatin C), mSchwartz (serum creatinine), and CKiD (serum cystatin C, creatinine, urea, and height). Mean GFR by all formulas differed significantly from NM‐GFR. Filler and mSchwartz formulas significantly increased the proportion of patients with GFR ≥ 90 mL/min/1.73 m² (CKD stage 1) while decreasing those with GFR 60–89 mL/min/1.73 m² (CKD stage 2). All formulas overestimated GFR. CKiD showed the highest P30 and lowest bias (79.7%; 6.9 mL/min/1.73 m²) followed by Filler (67.7%; 19.9 mL/min/1.73 m²) and Schwartz (57.6%; 26.8 mL/min/1.73 m²) for all GFR values. All formulas performed best with GFR ≥ 90 mL/min/1.73 m², but CKiD was the only formula to achieve 91.1% accuracy. All formulas showed high sensitivities, but low specificities at NM‐GFR cutoff at 90. Thus, GFR estimated by CKiD followed by Filler formula is an adequate method to monitor renal function closely and frequently in these children.     

Safety and pharmacokinetics of daclizumab in pediatric renal transplant recipients

Abstract:  This study examined the safety and pharmacokinetics/pharmacodynamics of daclizumab in combination with mycophenolate mofetil (or azathioprine), corticosteroids, and cyclosporine or tacrolimus, in 61 pediatric renal allograft recipients in three age groups: less than or equal to five yr (n = 18), 6–12 yr (n = 18), and 13–17 yr (n = 25). The dosing regimen was daclizumab 1.0 mg/kg before transplantation, followed by four biweekly doses. The pharmacokinetics of daclizumab were described using NONMEM software. Median (range) estimated trough daclizumab levels achieved on day 56 (before dose 5) were 3.88 μg/mL (2.48–8.78), 4.54 μg/mL (1.79–18.7), and 4.94 μg/mL (0.05–10.6) in the less than or equal to five yr (n = 15), 6–12 yr (n = 17), and 13–17 yr (n = 22) age groups, respectively. Steady-state median (range) daclizumab exposures were 2040 mg · h/mL (1585–3778), 2757 mg · h/mL (1873–3494) and 3297 mg · h/mL (1705–6453), respectively. Saturation of the IL-2R occurred rapidly and was maintained for greater than or equal to three months after transplantation. Daclizumab was generally well-tolerated with no acute allergic or anaphylactic reactions, deaths or malignancies during the study. The proportion of patients who developed acute rejection at six and 12 months was 8.5% and 16.7%, respectively. This study shows that adding daclizumab at 1 mg/kg to standard immunosuppressive therapy provides safe and effective IL-2R blockade.